Enzinger And Weiss Soft Tissue Tumors 6th Edition Pdf |VERIFIED| Free 64
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Anatomic location and dimension are important factors in the management of soft tissue sarcomas. Multiple surgical options exist and the choice of one over another is often based on surgeon preference. The surgical options include wide excision, marginal excision, curettage, and amputation. Although amputation is the most common therapy, limb-sparing options are accepted, based on the tumor location and size (5). Surgical excision is the mainstay of treatment in patients with low-grade or superficial tumors. However, if the tumor is aggressive or deep, therapy is more complex and involves amputation or amputation with adjuvant radiation therapy (RT) (5). The role of surgery in the treatment of malignant SFT is unclear. For example, radical resection has been suggested for high-grade malignant SFT and even excisional biopsy has been suggested for small, benign tumors with aggressive behavior. Despite increasing evidence against surgery in limb-sparing treatment of malignant SFT [44,45], surgery still remains the standard for high-grade malignant SFT. However, the limits of surgery in benign SFT are unclear.
The current study showed that patients with higher-grade tumors had a worse prognosis. This finding is similar to other studies that have reported that increasing histologic grade and size of the tumor are associated with more aggressive behavior. This may indicate that an aggressive approach in the form of an unplanned excision may be indicated for higher-grade sarcomas. Of note, tumors with unplanned excisions were significantly larger than those subjected to planned excisions (Tables 1 and 2). This is in contrast to previous studies (5, 14), where patients with unplanned excisions had smaller tumors. This may reflect different patient population and spectrum of tumors seen in the two studies. The current study, as well as previous studies, suggested that unplanned excisions might be associated with a more aggressive tumor biology and worse prognosis. However, given the small sample size, the lack of long-term data, the lack of uniformity in surgical approach, as well as the patient heterogeneity, it remains to be seen whether the impact of unplanned excision on prognosis is significant. It is also unclear whether a planned excision can eliminate the risk of malignant transformation. To elucidate this issue, larger studies are warranted.
The prognosis of SFT is excellent with a 10-year disease-free survival of 98% . The 5-year disease-free survival rates for localized tumors treated with surgery alone were reported at over 92% and for localized tumors treated with surgery plus radiotherapy at more than 94% . In the present study, all patients had good outcomes except for one with tumor recurrence. This patient received adjuvant radiotherapy despite being an extremity tumor. Although there have been no reports of local recurrence in extremity SFTs, local recurrence is reported in 24% of patients with extremity soft tissue sarcomas , and the recurrence rate is reportedly higher for tumors in the extremity than in the trunk . Considering the high recurrence rate of soft tissue sarcomas in the extremity, adjuvant radiotherapy may be beneficial for extremity tumors. 827ec27edc